Clinical Research and Application of Robot-Assisted Percutaneous Fixation of Atlas Fractures

Abstract

Objective: To systematically evaluate the clinical efficacy, biomechanical characteristics, and functional preservation advantages of robot-assisted percutaneous single-segment posterior fixation for atlas fractures. Methods: A retrospective analysis included 43 patients with atlas fractures admitted to Dazhou Orthopedic Hospital and collaborating hospitals between January 2022 and December 2024. Patients were randomized into a robot-assisted group (n = 21) and a traditional open surgery group (n = 22). Primary outcomes included screw placement accuracy (Gertzbein-Robbins grade A/B defined as successful), intraoperative blood loss, hospital stay duration, postoperative pain scores (VAS), and cervical range of motion (CROM scale). The robotic group underwent percutaneous single-segment fixation using the Tuodao Orthopedic Spinal Robot (NS100) for 3D navigation planning and dynamic tracking, while the traditional group received open posterior atlantoaxial fusion. Results: The robotic group demonstrated significantly higher screw placement accuracy 97.6% (41/42 screws) vs. 84.1% (37/44 screws) (P < 0.01). The robotic group also showed superior outcomes in intraoperative blood loss (35 ± 12 mL vs. 180 ± 45 mL, P < 0.001), hospital stay (4.2 ± 1.3 days vs. 8.5 ± 11.1 days, P<0.01), and improvement in 1-week postoperative VAS scores . At 6-month follow-up, the robotic group preserved >80% cervical rotation function, whereas the traditional group exhibited complete loss of upper cervical mobility (P < 0.001). Conclusion: Robot-assisted technology enables submillimeter-level navigation (error <0.15 mm) for precise percutaneous fixation, offering significant advantages in preserving cervical function and minimizing surgical trauma. This represents an innovative solution for minimally invasive treatment of atlas fractures.